In 2017, Adree Edmo, a transgender woman serving a 10-year prison sentence at the all-male Idaho State Correctional Institution, sued the Idaho Department of Correction and the prison’s health care provider, Corizon Inc. They had repeatedly denied her request for gender confirmation surgery, a procedure that would allow Edmo’s physical body to align with her female identity. When asked in court about the conflict between her biological sex and gender identity, Edmo responded, “I feel disgusting, I feel tormented, I feel hopeless.”

Edmo’s attorney argued that in order to stop these feelings and save her life, her client needed the surgery. In December 2018, the Idaho District Court ruled in Edmo’s favor. Then, this August, a three-judge panel from the 9th U.S. Circuit Court of Appeals upheld that decision: Prison authorities “were deliberately indifferent” to Edmo’s medical needs, they wrote, and that constitutes cruel and unusual punishment and is against the law. Edmo is expected to receive the surgery as soon as possible, though Idaho Gov. Brad Little has said he will appeal the decision to the Supreme Court, which could delay the procedure.

In addition to changing Edmo’s life, the ruling will expand access to medical care for prisoners across the West. The 9th Circuit’s acknowledgment of gender confirmation surgery as a medically valid treatment could encourage other prisons within its jurisdiction to offer it. Edmo’s case, lawyers say, could serve as a guide for other trans prisoners, and even advance recognition of transgender rights overall.

Edmo’s fight for gender confirmation surgery began after she entered prison in 2012, where she is serving a sentence for the sexual abuse of a 15-year-old boy when she was 21. Soon after starting her sentence, she was diagnosed with gender dysphoria, a condition where a person experiences discomfort or distress because of the mismatch between their biological sex and gender identity. She started hormone therapy, which includes taking estrogen to develop more feminine physical characteristics. But after five years of severe gender dysphoria, two attempted self-castrations and continued denial of gender confirmation surgery by prison authorities, Edmo filed her lawsuit.

The seriousness of gender dysphoria is well known throughout the medical world, said Erica Anderson, a clinical psychologist who works with transgender patients at a University of California, San Francisco clinic. And Edmo’s self-harm “is not at all unusual,” said Anderson. “I have had children who have taken out shears to try to cut off their penis,” she said. “This is how horrible gender dysphoria is for some.”

Luna Anna Archey/High Country News

Not all transgender individuals require surgery; for some, the physical changes less invasive treatments bring are sufficient to help them feel at home in their body. For others, though, the surgery is essential. The ruling in Edmo’s case doesn’t mean that prisons will have to provide all transgender inmates with surgery. However, it does set a precedent that the procedure is medically necessary for prisoners suffering from severe gender dysphoria.

For lawyers across the country, the 9th Circuit’s decision was a long time coming. For nearly two decades, courts have been battling over the medical needs of transgender prisoners, specifically gender reassignment surgery and hormone replacement therapy. Typically, prison facilities either deny such inmates care altogether or are too poorly equipped to provide it, said Gillian Branstetter, the spokesperson for the National Center for Transgender Equality. The 9th Circuit’s ruling will further help a vulnerable population receive adequate treatment while behind bars.

However, Little’s plan to appeal to the Supreme Court could change that. In similar cases from the 5th and 1st circuit courts, judges ruled against providing inmates with gender confirmation surgery, creating a split among the circuit courts and increasing the likelihood that the Supreme Court will agree to hear Edmo’s case. That would greatly increase the stakes: If the Supreme Court rules in Edmo’s favor, the decision could extend past the 9th Circuit to the entire nation, but if the ruling is overturned, transgender inmates will lose the precedent it set. The state has until Nov. 21 to submit an appeal.

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In the meantime, prisoners across the nation can use the 9th Circuit’s decision to bolster their own cases. This is a “groundbreaking decision in this country,” said Molly Kafka, the interim legal director at the ACLU of Idaho. “It provides a road map as to how other trans prisoners can use this decision to advocate for themselves if they are not receiving medical treatments.” In fact, Kafka said, she has already seen some colleagues analyze pending lawsuits with Edmo’s case in mind. Additionally, inmates with other ailments can use the ruling to support their own medical rights.

And, according to Kafka, lawsuits like these are bound to influence social views on transgender individuals. “Prisons are part of our society and communities,” she said. “When courts uphold the rights and dignity of transgender prisoners, it will have an effect on the public.”

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